Provider Demographics
NPI:1598191686
Name:AIRTH, LOGAN N (CRNA)
Entity Type:Individual
Prefix:MISS
First Name:LOGAN
Middle Name:N
Last Name:AIRTH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LOGAN
Other - Middle Name:N
Other - Last Name:AIRTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:3948 3RD ST S # 202
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-5847
Mailing Address - Country:US
Mailing Address - Phone:315-481-6965
Mailing Address - Fax:
Practice Address - Street 1:7700 W SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-4113
Practice Address - Country:US
Practice Address - Phone:315-481-6965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-20
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9472089207L00000X
NY100878367500000X
NY553113-1367500000X
FLARNP9472089367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology